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A Head-to-Head Comparison of the EQ-5D-5L and AQoL-8D Multi-Attribute Utility Instruments in Patients Who Have Previously Undergone Bariatric Surgery

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Abstract

Background

Psychosocial health status is an important and dynamic outcome for bariatric/metabolic surgery patients, as acknowledged in recent international standardised outcomes reporting guidelines. Multi-attribute utility-instruments (MAUIs) capture and assess an individual’s health-related quality-of-life (HRQoL) within a single valuation, their utility. Neither MAUIs nor utilities were discussed in the guidelines. Many MAUIs (e.g. EQ-5D) target physical health. Not so the AQoL-8D.

Objectives

Our objective was to explore agreement between, and suitability of, the EQ-5D-5L and AQoL-8D for assessing health state utility, and to determine whether either MAUI could be preferentially recommended for metabolic/bariatric surgery patients.

Methods

Utilities for post-surgical private-sector patients (n = 33) were assessed using both instruments and summary statistics expressed as mean [standard deviation (SD)] and median [interquartile range (IQR)]. Interchangeability of the MAUIs was assessed with Bland–Altman analysis. Discriminatory attributes were investigated through floor/ceiling effects and dimension-to-dimension comparisons. Spearman’s rank measured associations between the instruments’ utility values and with the body mass index (BMI).

Results

Mean (SD) EQ-5D-5L utility value was 0.84 (0.15) and median 0.84 (IQR 0.75–1.00). Mean (SD) AQoL-8D utility value was 0.76 (0.17) and median 0.81 (IQR 0.63–0.88). Spearman’s rank was r = 0.68; (p < 0.001); however, Bland–Altman analysis revealed fundamental differences. Neither instrument gave rise to floor effects. A ceiling effect was observed with the EQ-5D-5L, with 36 % of participants obtaining a utility value of 1.00 (perfect health). These same participants obtained a mean utility of 0.87 on the AQoL-8D, primarily driven by the mental-super-dimension score (0.52).

Conclusions

The AQoL-8D preferentially captures psychosocial aspects of metabolic/bariatric surgery patients’ HRQoL. We recommend the AQoL-8D as a preferred MAUI for these patients given their complex physical/psychosocial needs.

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Authorship

Julie Campbell contributed to study design, data verification and analysis, manuscript preparation and final approval. Andrew Palmer contributed to study design, manuscript review and final approval. Alison Venn contributed to study design, manuscript review and final approval. Melanie Sharman contributed to data collection and verification, manuscript review and final approval. Petr Otahal contributed to statistical analysis, manuscript review and final approval. Amanda Neil contributed to study design, data analysis, manuscript preparation and final approval. Amanda Neil is the overall guarantor of the submission.

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  1. Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia

    Julie A. Campbell, Andrew J. Palmer, Alison Venn, Melanie Sharman, Petr Otahal & Amanda Neil

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  1. Julie A. Campbell
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Correspondence to Amanda Neil.

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Disclosure of potential conflicts of interest

This work was supported by a National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP1076899). AV is supported by a NHMRC Research Fellowship. AN is supported by a Select Foundation Research Fellowship.

Research involving human participants

Ethics approval was granted by the University of Tasmania’s Health and Medical Human Research Ethics Committees.

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Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors Julie A. Campbell, Andrew J. Palmer, Alison Venn, Melanie Sharman, Petr Otahal and Amanda Neil declare that they have no conflicts of interest.

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Campbell, J.A., Palmer, A.J., Venn, A. et al. A Head-to-Head Comparison of the EQ-5D-5L and AQoL-8D Multi-Attribute Utility Instruments in Patients Who Have Previously Undergone Bariatric Surgery. Patient 9, 311–322 (2016). https://doi.org/10.1007/s40271-015-0157-5

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